More Older Americans Are Aging Alone. Who Will Take Care of Them?

Most live alone. One woman in her 80s told him he was the first human she had seen in two weeks. “I become friends with most of them,” he says.

Johnson works for Mountain Empire Older Citizens, a nonprofit organization that began 51 years ago with three people who organized a meal-delivery program in the Appalachian Mountains of southwest Virginia. Its mission then, as now, was to help older adults live independently.

Doing so has become increasingly difficult as people live longer, often with chronic conditions, and don’t have family members around to help.

More than 16 million people aged 65 and older in the U.S. live alone. That represents 28% of that age group, almost triple the share in 1950. Among the reasons: increased longevity, higher divorce rates among older adults and children more scattered than previous generations.

“It’s very likely most of us will live alone in old age,” says Elena Portacolone, professor at the Institute for Health & Aging at the University of California, San Francisco. Older adults with more financial resources have more care options, but even those with resources may find themselves hunting for in-home help. 

Duane Johnson arrives at Mountain Empire Older Citizens early to load his truck with boxes of frozen dinners to be delivered to older people living on mountain roads and in small towns.

Most people are unprepared to age alone. Only one-fourth of those living alone have someone who helps or would help with cooking, cleaning and getting groceries, and more than 80% haven’t planned for ongoing living assistance, according to an AARP 2023 report. At least one-fourth of older adults with dementia live alone.

Who will take care of them? “That is the million dollar question,” says Susan Brown, co-director of the National Center for Family and Marriage Research at Bowling Green State University in Ohio. “It’s a huge issue and one we are not paying enough attention to.”

In some places such as Norton, a city in the Mountain Empire region, 54% of those 65 and older live alone, according to the National Center.  

The growth of home-alone seniors needing assistance is stretching organizations such as Mountain Empire. It serves about 3,000 people, who are 60 and older, providing meals, transportation and personal care. It has a waiting list for homemaker help, but doesn’t have enough workers.

“There are older people in the area that no one is able to serve at the moment,” says Michael Wampler, the organization’s executive director.

Federal and state funding hasn’t decreased, Wampler says. But it hasn’t kept pace with rising costs and demand. The future is uncertain given proposed federal budget cuts and reductions in state funding.

Wampler and his staff have been resourceful, applying for grants, coming up with innovative Uber-like transportation and telehealth services and forming partnerships with local churches to help build wheelchair ramps. But needs keep growing.

Days begin early at Mountain Empire. Workers fan out to help people out of bed; drivers transport older adults to dialysis. Calls come into the office. Rebecca Gilly, director of in-home care, places personal-care aides and homemakers into homes across the three-county territory, but doesn’t have enough workers to go around.

Johnny Mumpower has kidney disease, gets meals delivered and is on the waiting list for homemaker help. “It’s hard to push a vacuum with a walker,” she says. Mumpower’s only immediate family, a brother, lives four hours away.

“My staff is great. I just don’t have enough,” says Gilly, an RN. 

Personal-care aides, who help with bathing and dressing, start at $12.75 an hour and can earn $15.22 after 10 years. Homemakers, who do light housekeeping, prepare meals and shop for groceries, start at $12.50 and earn $14.93 after a decade. 

The jobs aren’t easy. Robin Marshall drives to remote parts of Mountain Empire’s territory to care for two bed-bound clients. The personal-care aide gets them out of bed, bathed and dressed, takes their temperature and blood pressure, makes breakfast and cleans dishes. One man, a double amputee, is divorced, and has no children around. 

Many of those aging alone here, as elsewhere, are women who outlived their spouses. Verna Gilbert, 84, nursed her mother, her mother-in-law and her husband, who died almost 20 years ago. She has been in her home for 60 years and wants to stay there. Home-delivered frozen meals help stretch her income.

They often rely on neighbors. Kelly Hill, 87, lost her husband 19 years ago. A 74-year-old neighbor, who also lives alone, checks on her daily. Hill receives home-delivered meals and is on the waiting list for homemaker help.

Often people need more help than expected, especially as they age, which can strain resources.

Tiffany Jacobs, care-coordination director, received a request for meals to be delivered to a man recently released from a nursing home where he was receiving rehabilitation after falling. She asked one of her workers Kayla Mullins, 34, to assess his needs.

Mullins found the man, a 69-year-old retired factory worker, wearing several layers of clothes and a hat inside his mobile home. Wet insulation dangled from the ceiling. The roof had holes. He had a $2,000 utility-bill balance and wasn’t eligible for Medicaid. 

Mullins learned that his wife died three years earlier and his life had unraveled since. He had diabetes and chronic obstructive pulmonary disease. A daughter, herself sickly, was unable to help. 

Rebecca Gilly, left, and Kristen Rutherford each coordinate efforts to help older adults live independently.

Mountain Empire provided $300 to keep his power on while Mullins found him an apartment. She and her husband moved him in. “I cried a few times, just in private, to see him in the situation he was in,” she says, adding that he is now thriving.

More than one-third of the organization’s 258 workers, most of whom are paid hourly, are over 60. They are reliable. The drivers know the back roads.

They also have their own health concerns. Kristen Rutherford, director of nutrition, learns that an assistant meal site manager, who is in her 80s, needs days off for a heart-stent procedure. Only one of Rutherford’s staff of 15 is under 60. 

Johnson, who delivers the frozen meals to homebound older adults, is 73. He started three years ago because he needed money to pay $40,000 in medical bills related to his colon cancer and his wife’s ovarian cancer. He works four days a week, earning $13 an hour.

“I could be working somewhere else and making a whole lot more, but I wanted to give back to the community,” he says. His pastor told him to take time to talk with people because he might be the only person they see.

“Everyone has a story,” he says. 

Terry Roberts, 68, says he planned to work until he was 70 at his job cutting trees, until a “tree accident retired me,” resulting in several surgeries. Roberts doesn’t have a car. He drives his riding mower to the nearby Dollar Store and uses Mountain Empire transit for doctor’s appointments. 

Roberts asks about Johnson’s wife. She was cancer-free on the last scan, Johnson tells him. 

Johnson stops by one small house, engulfed in waist-high weeds, a tarp covering a broken window. An older woman comes out. Adult protective services had checked on her and found her competent. Johnson talks with her and says he will be back in two weeks.

It bothers him to see her alone in that house, but he takes heart knowing she has 10 nutritious meals. “I can’t fix everything.”

Write to Clare Ansberry at clare.ansberry@wsj.com